Now imagine that such a system costs less per person than private insurance, or Medicare.
That system is available to Alaska natives in Anchorage, Alaska and is the primary care center run by SouthCentral Foundation (SCF) – of which I am proud to be a member of their board of directors.
Southcentral Foundation (SCF) is a nonprofit health care organization established in 1982 to improve the health and social conditions of Alaska Native and American Indian people, enhance culture, and empower individuals and families to take charge of their lives. SCF provides a wide range of programs to address physical, mental, and emotional wellness for about 55,000 Alaska Native and American Indian people. Of these, 45,000 reside in the Anchorage area and 10,000 live in 55 remote villages accessible only by plane. SCF’s total coverage area, known as the Anchorage Service Unit (ASU), spans some 100,000 square miles. The ASU is served by a network of 24 health care facilities, including SCF’s two primary care centers (Anchorage and Wasilla) and two clinics (Iliamna and McGrath), and 16 subregional centers that SCF partners with to provide regional support. SCF employs 1,487 people—of which 53 percent are Alaska Natives or American Indians—and reported $201.3 million in revenues in 2010.
The Commerce Department awarded Southcentral Foundation a national quality award in 2011, the Malcolm Baldrige award, because Southcentral Foundation not only had amazing efficiencies: emergency room use has been reduced by 50 percent, hospital admissions by 53 percent, specialty care visits by 65 percent and visits to primary care doctors by 36 percent. These efficiencies were not at the expense of patient care, and the cost was less than health inflation for the rest of the United States.
Overall, SCF has achieved significant improvements in a number of key areas, including same-day access to care, which has led to a 50 percent decrease in costly emergency room and urgent care visits; a decrease in specialty care by about 65 percent; a decrease in primary care visits by 36 percent; and a decrease in hospital admissions by 53 percent.
Same-day access is achieved through a system that allows customer-owners to arrange to see their primary care provider on the same day as long they call by 4 p.m. and arrive by 4:30 p.m. This ensures that 70 to 80 percent of appointment slots are open at the start of each day.
Among the family wellness objectives set forth by SCF is a strong effort to reduce the incidence and improve the management of diabetes, a condition experienced by Alaska Native and American Indian people at twice the national rate. Since 2009, performance levels for diabetes care exceed the 90th percentile of the Healthcare Effectiveness Data and Information Set (HEDIS), a tool used by the majority of America’s health plans to measure performance on important dimensions of care and service. HEDIS measures different areas of diabetes prevention, diagnosis, and treatment such as ensuring that diabetic patients receive their annual HBA1c screening (a test that measures blood sugar levels over a period of three months), and treating diabetic nephropathy (kidney disease and damage).
But we also attribute our success to the change in culture from the IHS type, to where patients are no longer called patients, but called “customer-owners.” Our board of directors are all Alaska Natives, and have direct input into this vision. The center is directed by a mission statement, ” Working together with the Native Community to achieve wellness through health and related services.”
This even goes to the architecture of the facility. There are no private offices for physicians, nurses, no nursing stations- all health care providers, which include support staff, sit in a common area. This allows free and open communication between the providers. The waiting areas are large, and allow family members to sit comfortably. There are examination rooms, but also family rooms where all can discuss issues.
When some say the government cannot do anything right- this system proves they can. While it is run locally, the system is funded by a block grant from the Indian Health Service, and accepts insurance payments, including Medicare.
